SHAWNTAE JACKSON

PORTLAND, OR
NPI1558071399
Former NameSHAWNTAE COOPER
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy3747P1801X Technician, Personal Care Attendant
Enumeration Date2022-12-02
Last Update Date2022-12-02
Business Address
SHAWNTAE JACKSON
2270 NW OVERTON ST
PORTLAND, OR 97210-2927
Phone number: 503-241-6051
Mailing Address
SHAWNTAE JACKSON
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number:
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